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Clinical informatics (CI) is a dynamic field at the intersection of health care, technology, and information science, aimed at enhancing health care delivery and patient outcomes. CI fellowship programs prepare physicians to lead and apply health information technologies that drive improvements in clinical care, system efficiency, and innovation. Achieving Accreditation Council for Graduate Medical Education (ACGME) accreditation for such programs is crucial for standardizing training and ensuring the development of [...]

Electronic health records (EHRs) have revolutionized clinical practice, but clinicians and institutions have not yet fully optimized their use. Inconsistent documentation of ophthalmic test results can increase potential medicolegal risks if providers bill for tests without properly documenting clinical interpretations.To address this, we developed and implemented a logic tool in Epic (Epic Systems, Verona, Wisconsin, United States) that prompts clinicians to document diagnostic test interpretations as discrete data before closing [...]

Electronic patient-reported outcome measures (ePROMs) can improve care for people with cancer, but effectiveness hinges on well-supported integration in clinical settings.We evaluated clinician use of specific clinical decision support (CDS) tools in the electronic health record (EHR) designed to facilitate timely, clinically appropriate responses to ePROM scores for six symptoms commonly experienced by cancer patients.The parent pragmatic trial, which took place at Mayo Clinic (Rochester, Minnesota, United States) and its [...]

Disparities exist in patient portal use among non-English-speaking caregivers of pediatric patients. This study aims to evaluate the reasons behind Spanish-speaking caregivers' use of patient portals and identify facilitators and barriers, focusing on those caring for children with chronic conditions.We conducted semi-structured interviews and surveys with Spanish-speaking caregivers of pediatric patients with chronic conditions at an academic pediatric health network in California. Data were transcribed, coded, and analyzed using inductive [...]

Nursing documentation burden is a growing point of concern in the United States health care system. Documentation in the electronic health record (EHR) is a contributor to perceptions of burden. Efficiency tools like flowsheet macros are one development intended to ease the burden of documentation.This study aimed to evaluate whether flowsheet macros, a documentation efficiency tool in the EHR that consolidates documentation into a single click, reduces the time spent [...]

The purpose of this systematic literature review is to critically evaluate the use of mathematical and simulation models within emergency departments (EDs) and assess their potential to improve the quality of care. This review emphasizes the critical need for quality enhancement in health care systems, with a specific focus on EDs.This review incorporates studies that have investigated the quality of care provided in ED settings, employing assorted mathematical and simulation [...]

This study aims to improve concordance between patient end-of-life preferences and code status orders by incorporating data from a state registry with clinical decision support (CDS) within the electronic health record (EHR) to preserve patient autonomy and ensure that patients receive care that aligns with their wishes.Leveraging a health information exchange (HIE) interface between the New York State Medical Orders for Life-Sustaining Treatment (eMOLST) registry and the EHR of our [...]

Retinopathy of prematurity (ROP) is the leading cause of preventable childhood blindness. Guidelines recommend screening for infants with gestational age at birth <31 weeks or birth weight ≤1,500 g. However, ensuring timely screening during readmissions after birth is challenging.To analyze the performance of an interruptive alert at a large academic pediatric hospital for identifying premature infants needing ROP screening upon hospital readmission and to describe how data informed the transition to a non-interruptive dashboard.The alert appeared for patients 1 to 365 days of age hospitalized in acute care or pediatric intensive care and instructed providers to order an ophthalmology consult from within the alert and to call ophthalmology for at-risk patients. For quality improvement, the clinical decision support (CDS) advisory group evaluated the effectiveness and efficiency of the alert. We extracted alert metrics from the hospital's enterprise data warehouse, including the user response and feedback, patient characteristics (age, birth gestational age, and birth weight), and any ophthalmology consultations. We analyzed the percentage of encounters seen by ophthalmology using a statistical process control chart during alert implementation and 6 months before and after.The alert appeared 3,309 times during 2,194 patient encounters usually. Users chose "Accept and place order" for 43% (943/2,194) of encounters, but only 11% (102/943) had an ophthalmology consult; 34% (53/155) of ophthalmology consultations occurred in encounters with a final response other than "Accept and place order." The intervention was redesigned using a non-interruptive surveillance dashboard with greater specificity, and the alert was de-implemented.Analysis of a failed interruptive alert for identifying patients at risk for ROP led to a transition to targeted surveillance using a dashboard. This case emphasizes the importance of aligning the CDS modality to the clinical workflow, information availability, and user decision-making needs and should be supported by governance.

Electronic health record (EHR) usage measures may quantify physician activity at scale and predict practice settings with a high risk for physician burnout, but their relation to experiences is poorly understood.This study aimed to explore the EHR-related experiences and well-being of primary care physicians in comparison to EHR usage measures identified as important for predicting burnout from a machine learning model.Exploratory qualitative study with semi-structured interviews of primary care physicians [...]

Artificial intelligence (AI) scribes use advanced speech recognition and natural language processing to automate clinical documentation and ease administrative burden. However, little is known about the effect of AI scribes on clinicians, patients, and organizations.This study aimed to (1) propose an evaluation framework to guide future AI scribe implementations, (2) describe the effect of AI scribes along the domains proposed in the developed evaluation framework, and (3) identify gaps in [...]